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The use of rotational atherectomy in high-risk patients: results from a high-volume centre
Piotr Kübler1, Wojciech Zimoch, Michał Kosowski
1Wroclaw Medical University, Department of Heart Diseases, Weigla 5, 50-981 Wroclaw, Poland; Military Hospital, Weigla 5, 50-981 Wroclaw, Poland. pkubler75@gmail.com.
Insights
Rotational atherectomy (RA) offers comparable outcomes for high-risk patients as for lower-risk patients. This complex percutaneous coronary intervention (PCI) is a viable option when other revascularization methods are not feasible.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Rotational atherectomy (RA) is crucial for treating complex fibrocalcified coronary lesions.
- It serves as a last resort for revascularization in high-risk patients, including those unsuitable for coronary artery bypass grafting (CABG).
Purpose of the Study:
- To compare in-hospital and one-year outcomes of percutaneous coronary intervention (PCI) with RA in high-risk patients (RA-only group) versus lower-risk patients undergoing RA.
- To evaluate the efficacy and safety of RA as a primary revascularization strategy in select patient populations.
Main Methods:
- A retrospective analysis of 207 consecutive patients undergoing PCI with RA.
- Primary endpoints included one-year all-cause mortality and major adverse cardiac events (MACE).
- Secondary endpoints focused on in-hospital outcomes, comparing a high-risk RA-only group with lower-risk RA patients.
Main Results:
- High-risk patients (35% of cohort) exhibited poorer baseline characteristics (lower ejection fraction, prior CABG, higher scores).
- Procedural success rates were similar between groups (85% vs. 91%).
- One-year MACE (19% vs. 18%) and mortality (11% vs. 9%) rates did not differ significantly, despite more frequent no/slow-flow in the RA-only group.
Conclusions:
- High-risk patients undergoing RA as a sole revascularization option experience comparable in-hospital and one-year outcomes to lower-risk RA patients.
- Complex PCI with RA should be considered for patients lacking alternative revascularization strategies.
Background:
Rotational atherectomy (RA) is indicated for fibrocalcified lesions when traditional percutaneous coronary intervention (PCI) could not be successfully performed. In some of the high-risk patients the RA procedure is the last resort for successful revascularisation. Such patients are, among others, those in whom coronary artery bypass grafting (CABG) is not feasible.
Aim:
The aim of the study was to assess in-hospital and one-year outcomes of PCI with RA in high-risk patients without other revascularisation options (RA-only group), in comparison to lower-risk patients undergoing RA.
Methods:
We evaluated data of 207 consecutive patients who underwent PCI with RA. Primary endpoints were one-year all-cause mortality and one-year major adverse cardiac events (MACEs). Secondary endpoints were in-hospital outcomes.
Results:
During the study 35% of patients fulfilled the inclusion criteria to the high-risk group. Those patients had significantly lower left ventricular ejection fraction, more often prior CABG, higher admission glucose level, and higher EuroSCORE II and Syntax Score. Procedural success was similar in both groups (85% in RA-only group vs. 91% in remaining patients, p = 0.18). In-hospital outcomes were similar, except more frequent no/slow-flow phenomenon in the RA-only group. The MACE and mortality rates in one-year follow-up were not statistically different in both groups (19% vs. 18%, p = 0.82 and 11% vs. 9%, p = 0.64, respectively).
Conclusions:
Despite the high-risk characteristics of the study subgroup, no significant differences between in-hospital and one-year outcomes were found in comparison to lower-risk RA patients. Complex PCI with RA in patients without other revascularisation options should be taken into consideration.
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